Following the birth of your baby, whether that is by vaginal birth or caesarean section, pelvic health physiotherapists can assist you in your antenatal recovery.
Some common concerns include:
- Pelvic floor or abdominal muscle weakness
- Bladder or bowel leakage
- Bladder or bowel urgency, “when you got to go, you’ve got to go!”
- Haemorrhoids and anal fissures
- Painful episiotomy or c-section scar tissue
- Heaviness/dragging feeling in the vagina or perineal area
- Pelvic organ prolapse (Bladder, bowel or uterus)
- Rectus Abdominus Diastasis
- Pain in the low back or pelvis
- Pain with intercourse
- Neck and upper back pain
- Wrist pain/numbness
- Breastfeeding issues, such as mastitis or cracked nipples
Returning to Exercise After Birth
Regaining strength and tone, improved sleep and energy levels, as well as managing stress, are just some of the benefits to getting back into exercise and sport after childbirth. Knowing which exercises are best and when to start can be difficult. Our pelvic health physiotherapists are the best place to design a safe graduated exercise program to help you meet your goals.
Before designing a program, our physiotherapists will do a comprehensive assessment including a specific assessment of your pelvic floor and abdominal muscles. Assessment of the pelvic floor can be performed via real-time ultrasound or a vaginal examination, depending on your needs and preference.
Your physiotherapist will then discuss the findings and create a specific exercise program to meet your individual needs and goals, including:
- Pelvic floor muscle training
- Strengthening of the abdominal muscles
- General body reconditioning
- Cardiovascular fitness advice
- Postural advice
Urinary leakage is very common following childbirth. In fact, one in three women who have had a baby will experience urinary leakage. If you have had a child, you are three times more likely to leak urine, than women who have not had children. The more children you have, the more chance you will have of leaking.
You are more likely to leak after having a baby as the pelvic floor muscles need to carry the additional load of your baby during your pregnancy, regardless of how you deliver your baby. These muscle helps to close the urethra (wee passage). The pelvic floor muscles and nerves in the pelvis can also experience stretch as the baby passes through the birth canal.
There are two main types of urinary incontinence. The first is stress urinary incontinence which is leakage that occurs when you cough, sneeze, lift or do exercises. The other type of leakage is urge urinary incontinence and this leakage occurs when you cannot make it to the toilet in time and you leak on the way. Leakage does not improve if you ignore it. However, the good news is that strong evidence supports pelvic floor muscle training as an effective treatment for both types of urinary leakage.
Women can also experience anal incontinence following childbirth. This is leakage of wind or stool. This is most common in women who experienced a perineal tear which extended to their back passage during childbirth. If you experience any trouble controlling wind or stool, know that you are not alone and that physiotherapy can help.
Book in with one of our pelvic health physiotherapists and they will assess your pelvic floor muscles, help you understand why you are leaking, and set you up with a management plan to help you manage your bladder and bowel symptoms.
Pelvic organ prolapse management
Pelvic organ prolapse is common in women who have had a baby, with 50% of women who have had a vaginal delivery experiencing some degree of prolapse. The bladder, bowel or uterus can descend into the vagina, with the most common symptom being “the feeling of a lump or bulge protruding into the vagina”. Not all pelvic organ prolapse are bothersome.
If you have been diagnosed with pelvic organ prolapse, pelvic floor exercise and lifestyle modification can reduce the bother of the prolapse or prevent the prolapse from worsening. If you are experiencing any vaginal heaviness or pressure or can feel a lump or bulge in the vagina it is advisable that you see a physiotherapist to optimise your recovery.
Rectus Abdominis Diastasis (abdominal muscle separation) Rehabilitation
Stretched or weakened abdominal muscles after having a baby is common. In some women, the rectus muscle separates during pregnancy and this can be called a rectus abdominus diastasis or diastasis of rectus abdominus. Some separation of the rectus is normal, and this should start to close after you have given birth. In some women, the separation is greater, and recovery takes longer, some women notice that the muscles appear to “tent” or “dome” when they sit up and a gap can be felt between the stomach muscles.
Separation (diastasis) of rectus abdominus has been associated with larger babies or twins, poor posture and weakness of the lower abdominal muscles.
A specific exercise program in the postnatal recovery period can help recovery. It is important not to worry about this separation as it doesn’t increase a person’s risk of back and pelvic pain and with the right care and for most people it resolves over time
Painful Intercourse Following the Birth of Your Baby
Pain with sexual intercourse is common after having a baby. It is normal for your perineum to feel sore if you have had a vaginal delivery, especially if you have had a tear or episiotomy and stitches. This usually improves within 6 to 12 weeks after birth, but if it is not settling physiotherapy including perineal ultrasound may aid recovery.
It is normal for the vagina to feel drier than usual after childbirth. This is linked to lower oestrogen levels compared to during pregnancy. For breastfeeding mothers, the levels of oestrogen are lower than those who are not breastfeeding.
Returning to regular sex is an individual decision, and while most women wait until after their six week check-up with their doctor or obstetrician, some women wait longer. It is not unusual to feel less like sex than you used to at this time. After giving birth, you are often feeling tired from looking after a tiny baby. Don’t rush into it, if sex hurts it won’t be pleasurable. If your vagina feels dry, try a lubricant. It is important to talk about this with your partner rather than just avoiding sex. A common understanding can help people deal with it together.
In 20% of women, the pain with sex may become persistent and/ or severe and this can affect sexual relationships, desire and libido.
There are many causes of painful sex including:
- Sensitivity of the area of the stitches that has caused some scar tissue.
- Increased tension in the pelvic floor muscles.
- Involuntary contraction of the pelvic floor muscles during vaginal penetration, which is known as vaginismus.
- Increased sensitivity in the vulval /vaginal area, known as vulvodynia which is a condition where the region just outside the vagina is painful with a light touch or without any provocation at all.
Our physiotherapists are able to help you understand the factors that may be important for you and design a management program including learning how to relax the pelvic floor muscles and desensitise the sensitive tissue at the vaginal opening to help improve your symptoms.
Management of Mastitis and Blocked Milk Ducts in Breastfeeding Mothers
While an incredibly happy occasion, having a new baby can be a challenging time for many new mums who choose to breastfeed but experience difficulties with the development of mastitis and nipple trauma.
Ineffective attachment (also called latch) is often one of the main causes, which can lead to bacteria tracking back into the breast from a traumatized nipple and/or poor drainage of the breast during feeding. Seeking help from a lactation consultant, child health nurse or midwife is recommended to address the underlying causes of poor attachment and repeated infection.
Therapeutic ultrasound treatment has also been shown to be clinically effective in treating blocked milk ducts that may be limiting effective milk flow during feeding and potentially progressing to mastitis. Laser treatment is also effective in improving healing rates of painfully cracked and grazed nipples.
Our physiotherapists can assist you in the management of mastitis, blocked ducts and sore nipples, and prompt treatment recommended. Please inform our receptionists when booking your appointment so our physiotherapists can prioritise a suitable time.
After you have had your baby, a thorough assessment is essential to understand your problem. Our physiotherapists will take a thorough history, screen for factors that could be influencing your problem and establish your goals for treatment.
Following this, we will conduct a comprehensive assessment of your condition including assessment of your abdominal muscles and the ability to perform correct pelvic floor muscle contractions.
Assessment of the pelvic floor muscles can be done fully clothed using real-time ultrasound. For a more comprehensive assessment of pelvic floor muscles, a direct assessment can be performed via a vaginal assessment. This method is recommended for an accurate assessment of the strength of the pelvic floor muscles and for anyone experiencing pain. The method of assessing your pelvic floor muscles is always your choice and will be thoroughly explained and based on your consent.
Following the assessment, we will explain to you in simple terms the factors that may be impacting on your problem and design a collaborative treatment plan to help you achieve your goals.